Mozambique’s ambitious push against malaria

Mozambique, 2010 – After a 30-kilometre race on a motorbike and a twenty-minute blood test in a rural health clinic confirmed the worst – severe malaria with complications – three-year-old Bonita Gomes was rushed at midnight another 10 kilometres to the Tete provincial hospital where she now lies in a coma. Despite the blood transfusion and the quinine treatment, her survival hangs on luck at this point.

Bonita was fortunate that her parents wasted no time explains paediatrician Dr. Juliana Anibal Malichocha. “It is too early to say if she will survive; she is still in serious condition. But when they arrive early, we have a better chance to save them.”

Malaria is the primary killer of children under than five in Mozambique – a third of all children die from malaria. As in other African countries, it is not only one of the leading causes of death, but it also cripples productivity and contributes to poverty.

“There is no doubt that malaria represents a significant health burden in the province because it remains the first cause of consultation, the first cause of hospitalisation and the first cause of mortality, particularly among children aged between zero and five years old,” says Luisa Cumba, Tete Provincial Health Director.

For the past three years, Mozambique’s Ministry of Health has pushed an aggressive but strategic fight to reduce and ultimately prevent the deadly disease, with support from partners like the European Union, The Global Fund and UNICEF.

Eradicating the vector – mosquitoes that breed in stagnant pools of water – may be extremely difficult in the poor, hot-temperature central provinces, but a combination of measures is succeeding in mitigating the impact.

The roll out of rapid blood tests to all districts and strengthening case management means children like Bonita can get treated sooner, which is critical to prevent complications that can quickly kill a young child whose immune system is not fully developed. The focus now is on how to bring the services to the community rather than wait for patients to come to a clinic.

In addition to better treating cases, the ultimate challenge is to ensure people don’t get sick in the first place. The strategy’s success has been its focus on prevention and primarily the roll out of long-lasting insecticide-treated nets. Since 2000, 7.2 million nets have been distributed in Mozambique, of which 2.7 million where handed out with UNICEF support. The priority has been pregnant women and children under five 5 years, who remain the most vulnerable.

Aida Olimpio, 22, is six months pregnant and has arrived for her antenatal consultation – a day’s walk to the São José Mavuzi Ponte Health Clinic, a rural outpost in Chiuta district. While she waits, she listens to a health worker explain the value in sleeping under a treated mosquito net. Having lost her first child because of fever, she pays close attention.

After the examination, Aida is given Fansidar™, a prophylactic treatment that helps to fend off malaria, iron tablets to help prevent anaemia and a new net to take home.

In one year’s time, the results have been almost staggering says Dr. Cumba, who spearheads the Tete provincial campaign. “We’ve had a reduction by 68 per cent in the number of cases and 89 per cent in the number of deaths.”

Using lessons from the success of a piloted project in Gaza province, the national strategy now looks to provide nets to the whole population. An ambitious project, it will require a massive commitment to ensure there are enough nets to go around.

In Kaunda district, the scorching heat does not deter thousands of people who waiting for a net. Since early morning, health teams have been calling one village at a time and handing over three to five nets per family. Over ten days, 30,000 nets will be distributed. The cost of travelling to town to buy a net, almost 100 kilometres for some families, would be prohibitive. The Ministry of Health spent months planning this distribution, having gone door to door to calculate the number of nets needed.

Dispensing nets will indeed be critical. But there is an even greater hurdle in getting people to actually string them up.

“Distributing these nets is one thing, especially to the hardest to reach, but getting people to use them is another thing,” says Paul Ngwakum, UNICEF Mozambique. “Education is not easy as we must convince people to change their behaviour. And some people will sell their nets. But the good news is that over the years, the numbers of people sleeping under a net has increased.”

According to a 2008 government survey, the number of people sleeping under a net has increased from 16 to 48 per cent since 2003.